Pediatric abusive head trauma, also known as shaken baby syndrome, is a devastating form of abuse. It occurs when a young child is violently shaken. The repeated shaking back and forth motion causes the child’s brain to bounce within the skull, resulting in bruising and swelling. This intentionally inflicted injury causes trauma to the head and neck region, including cranial, cerebral, and spinal injuries. It occurs in infants and small children because the muscles of the neck region aren’t strong enough to go against the shaking force that occurs. Some make a complete recovery; others are left with debilitating handicaps, and in some cases death occurs. The Centers for Disease Control and Prevention (2012), states that among all the forms of child abuse, head trauma is the leading cause of death and disability and is the most preventable. Pediatric abusive head trauma has a greater mortality and morbidity than any other form of physical abuse. Early recognition and accurate diagnosis are essential for children that present with this traumatic injury. According to the Centers for Disease Control and Prevention (2012), the incidence of pediatric abusive head trauma vary, but most range from 20 to 30 cases per 100,000 children under 1 year of age. The incidence rate is noted to decrease with the increasing age of the child. The incidence is substantially higher with children 1 year of age and younger. The purpose of this paper is to discuss pediatric abusive head trauma, its physical manifestations, diagnosis and treatment, outcome and prognosis, and prevention and education.
Varying physical manifestations are present in abusive head trauma. There are usually many defining characteristics. Immediately the infant may experience vomiting, lethargy, fever, apnea, excessive crying and difficulty feeding (Stoll & Anderson, 2013). Retinal hemorrhage is present in approximately seventy five percent of all pediatric abusive head trauma cases (Mraz, 2009). The most commonly seen injury is hematomas. When the infant is shaken the excessive force placed on the skull and brain cause the vessels to tear leading to bleeding under the skull. Pediatric abusive head trauma patients may experience cervical spinal cord injury, fractures of the skull or ribs, dislocated joints, contusions, or death. The child may have microcephaly, hemiparesis, ataxia, cerebral palsy, cortical blindness, epilepsy, speech and language delays, global developmental delays, and behavioral dysfunction (Mraz, 2009). The child is left with a lifetime of disabilities and long-term care.
Diagnosis and Treatment
The core component to diagnosis and treatment begins with an impeccable history. According to the American Academy of Pediatrics (2009), guidelines for the suspected child physical abuse, any statement made by the caregiver regarding the injury should be documented accurately and a complete detailed history should be obtained in a non-accusatory manner. The...